A clinical analysis of 476 cases of
delirium tremens is presented. The sample covers virtually all cases of
delirium tremens that occurred in the Helsingborg Health Service District during the period 1975-1980. A retrospective analysis of the incidence of
delirium tremens over the observation period shows that there was an increase in the number and severity of cases developing
delirium tremens when non-cross-tolerant drugs, such as
carbamazepine and
neuroleptics, were used as first-line treatment for acute alcohol withdrawal. The results also show that when
chlormethiazole (a
drug exhibiting a certain degree of cross-tolerance with
ethanol) was used either as the first-line treatment for all cases or as the first-line treatment for predetermined "high risk" patients, the incidence of
delirium tremens was greatly reduced. The favourable findings when
chlormethiazole treatment was initiated at an early stage in the "high risk" patients suggest that
chlormethiazole has a protective action against
delirium tremens. Moreover, in the occasional case in which
delirium tremens occurred during
chlormethiazole treatment, the disorder was milder and relatively easy to treat.